Looking at the needs assessment process of students with
mental health difficulties:
The impact on learning and the student journey; Challenge of mental
health problems on daily living; DO role in assessment process;
findings from 1st year experience survey; Impact on learning –
Medication, treatments and supports.
Brendan Power
Disability Officer,
Trinity College Dublin
Presentation Overview
• Challenge of mental health problems on daily living.
• Findings from a 1st year experience survey.
• Medication and treatments and the impact on the student journey –
Case studies.
• The Disability Officer role in assessment process.
Trinity College Dublin, The University of Dublin
What is Mental Health?
Mental health and well-being are fundamental to our collective and
individual ability as humans to think, emote, interact with each other,
earn a living and enjoy life (World Health Organisation, 2013).
Good mental health is an integral component of general health and
well-being, allowing a person to fully realise his or her abilities. With a
balanced mental disposition, people are more effective in coping with
the stresses of life (Department of Health and Children, 2006).
Trinity College Dublin, The University of Dublin
Recovery in Mental Health
Doing with instead of for…
– A Recovery Approach within the Irish Metal
Health Services.
“The recovery approach in mental health
services emphasises the expectation of
recovery from mental ill health and
promotes both enhanced self-management
for mental health service users and the
development of services which facilitate the
individual’s personal journey towards
recovery”.
(Mental Health Commission, 2008)
Trinity College Dublin, The University of Dublin
Mental Health problems
Risk & Relevance in the student population
• The Lifetime occurrence of psychiatric disorders is frequent among
young Irish adults aged between 19 to 24 years (Harley et al, 2015).
• The risk of mental health difficulties exist at every level of
adolescence which highlights the importance that mental health is
every body’s business.
• At present, mental health services in Ireland are not configured to
support a model of continuing integrated care through adolescence
into young adulthood(Power et al, 2015).
• Many patients first experience mania or psychosis as adolescents or
young adults (Malhi, et al 2015).
Trinity College Dublin, The University of Dublin
Trinity College Dublin
Disability Service first year experience survey : Category of disability
)
ADD / ADHD
1%
Asperger’s
Syndrome
5%
Specific Learning Difficulty
(incl. Dyslexia and Dyscalculia)
21%
Blind/Vision Impaired
1%
Deaf/Hearing Impaired
4%
Dyspraxia
9%
Mental Health Condition
30%
Significant Ongoing
Illness
14%
Physical Disability
9%
Speech & Language
Disabilities
1%
Trinity College Dublin, The University of Dublin
Neurological Conditions
5%
Mental Health Conditions presented as
highest disability type in survey of first
year students registered with the Disability
Service
Mental Health problems
Medical management & Recovery
• Within a mental health context, the role of medication supports
personal recovery from periods of ill-health and is not just a
treatment but a tool that helps achieve personal recovery goals
(Baker et al, 2013).
• Medication management in Psychiatry has assisted in the care and
treatment of clients with differing mental health conditions for over
sixty years (Sheridan, 2008).
Trinity College Dublin, The University of Dublin
Mental Health problems
Disorders, conditions and medication management
Trinity College Dublin, The University of Dublin
Mental Health problems
Learning through experience
• Case studies are an invaluable record of both classical and unusual
presentations which may confront a service provider (Budgell, 2008).
• Two case studies will be presented:
1.
John
2.
Mary
Trinity College Dublin, The University of Dublin
Case Study - John
Introduction
• John is a thirty-five year old mature student studying social studies.
• His primary diagnosis is Chronic Fatigue.
• John also presents with secondary mental health problems,
exhibiting symptoms of anxiety and depression. He is in the care of a
community mental health team.
• John is registered with the Disability Services since entering into
college. Interventions provided included UNILINK support, exam
accommodations and the development of a Learning Educational
Needs Summary (LENS).
Trinity College Dublin, The University of Dublin
Case Study - John
Impact of disability on academic life
• John exhibits significant weakness in verbal memory, working
memory and speed of processing, affecting reading fluency,
comprehension, spelling and written expression.
• John also experiences visual stress when reading print.
• Patients with chronic fatigue syndrome (CFS) suffer from medically
unexplained and severely disabling fatigue that lasts for at least six
months (Wiborg et al, 2014).
• John also presents with secondary mental health problems,
exhibiting anxiety and depression.
Trinity College Dublin, The University of Dublin
Case Study - John
Role of the disability officer
• Just prior to commencing end of year exams, John had requested to
meet his assigned Disability Officer as he did not wish to proceed
with exams with the way he was feeling.
• During interactions with John to explore current circumstances his
current mental health problems were explored including what the
management plan of his condition. John then had outlined he was
actually going through a complete re-titration of a new medication
upon exploration of his care and treatment plan. New medication
was named as Sertraline.
• Pharmacological therapies are an important element of treatment
received by people with mental health problems (Doherty, 2014).
Trinity College Dublin, The University of Dublin
Case Study - John
• Medication: Sertraline
• Type: Anti-depressant - Serotonin reuptake inhibitor (SSRI)
Family
Generic drug
name
UK trade name
US trade name
Irish trade names
Anti-depressant
Sertraline
Lustral
Zoloft
Depreger,
Lustral
Sertraline is indicated for the treatment of:
• Major depressive episodes. Prevention of recurrence of major depressive episodes.
• Panic disorder, with or without agoraphobia.
• Obsessive compulsive disorder (OCD) in adults and paediatric patients aged 6-17 years.
• Social anxiety disorder.
• Post traumatic stress disorder (PTSD)
(www.medicines.ie)
Some side effects: Feeling drowsy or fatigued, inability to sleep, dry mouth, urinary difficulties, dyskinesia’s (involuntary
Trinity College Dublin, The University of Dublin
muscle movements),
tooth grinding, headache, blurred vision, weight gain, nausea, rashes and infections (Healy, 2005).
Case Study – Mary
Introduction
• Mary is a twenty year old general nursing student
• Her primary diagnosis is Bipolar Affective Disorder
• Mary also presents with secondary mental health problems,
exhibiting symptoms of anxiety.
• Mary is registered with the Disability Services since entering into
college. Interventions provided included UNILINK support, exam
accommodations, a Learning Educational Needs Summary (LENS) and
placement planning.
Trinity College Dublin, The University of Dublin
Case Study – Mary
Impact of disability on academic life
• Mary exhibits fatigue and tiredness on a daily basis. Her anxiety
increases in social gatherings and this impacts on small group work in
the course and on placement. Mary also has problems with working
memory which effects her spelling and written expression.
• Mary also must attend regular outpatient clinic appointments once a
month.
• Bipolar disorder is defined by its poles, elevated mood or irritability
characterises mania, and marked low mood and lack of energy
typifies depression (Malhi, 2015).
• Mary is currently on a placement and has been in contact to say she
hasn’t been attending over the last few days due to tiredness and not
waking up on time.
Trinity College Dublin, The University of Dublin
Case Study – Mary
Role of the disability officer
• Mary requested to meet her
disability officer
• Mary was assessed on her
current problem of nonattendance to placement and
symptom of tiredness.
• A placement planning meeting
was undertaken prior to Mary
commencing her placement
where fatigue was identified as
impacting on her.
• Mary was also provided with the
flexibility of shortening her
longer shifts.
Trinity College Dublin, The University of Dublin
Case Study – Mary
Role of the disability officer
• During interaction with Mary the absence from placement was
explored and her fatigue.
• The Disability Officer assessment explored current problem(s) to look
at rationale. There was no change in any circumstances but Mary did
report she had been commenced on a new medication, as a shortterm management plan.
• Mary reported that she takes Lithuim and has been on this for years
for her BPAD. She had been commenced on Olanzapine as she had
been feeling “a little off” and made an appointment with her
Consultant Psychiatrist.
Trinity College Dublin, The University of Dublin
Case Study – Mary
• Medication: Lithium Carbonate
• Type: Mood-stabiliser
Trinity College Dublin, The University of Dublin
Case Study – Mary
• Medication: Olanzapine
• Type: Second generation anti-psychotic
Family
Generic drug
name
UK trade name
US trade name
Irish trade names
Anti-psychotic
Olanzapine
Zyprexa
Zyprexa
Zyprexa,
Olanzapine
Mylan
Olanzapine is indicated for the treatment of:
• Schizophrenia.
• Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment
response.
• Moderate to severe manic episode.
• Patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of
recurrence in patients with bipolar disorder
(www.medicines.ie)
Some side effects: Stiffness/lack of movement (akinesia), abnormal muscle tone (dystonia), restlessness/agitation
Trinity
Dublin, The
University of Dublinweight gain, diabetes, sedation. (Healy, 2005).
(akathesia),
lackCollege
of interest
(demotivation),
Role of the Disability Officer (DO)
• Generating awareness to academic schools and departments during
routine training and DS activities of impact medications may have on
students.
• During student assessments DO’s should explore impact of
medication on individual and the associated side effects that could
result from treatments.
• DO role is not about knowing the wide array of medications but
exploring the medications with students and impact it may have on
their student journey.
Trinity College Dublin, The University of Dublin
Role of the Disability Officer (DO)
• Side-effects of medications are very individual and important to signpost student to the relevant services they are attending for
assistance.
• Medications are not specific to mental health treatments as there is
often a co-morbidity of more than one condition that affects
individuals.
i.e. Schizophrenia and diabetes – Student could be on anti-psychotic
medication and insulin therapy as part of their management for both
conditions.
Mind
Trinity College Dublin, The University of Dublin
Body
Holistic
Approach
Sources for general information on medication(s)
General Information
The information on medicines.ie relates to medicines available in
Ireland. It is the most comprehensive source of information on medicinal
products available in Ireland and is widely regarded as an invaluable
reference source by healthcare professionals, the Department of Health
and the Health Products Regulatory Authority.
Trinity College Dublin, The University of Dublin
Sources for general information on medication(s)
General Information
Health Service Executive – Republic of Ireland
http://www.hse.ie/eng/services/list/4/olderpeople/tipsforhealthylivin
g/drugsmedicine.html
National Health Service – United Kingdom
http://www.nhs.uk/medicine-guides/pages/browsebymedicine.aspx
Trinity College Dublin, The University of Dublin
Sources for general information on medication(s)
Mental Health Specific
Mind.co.uk – United Kingdom
http://www.mind.org.uk/information-support/drugs-and-treatments/
Choice & Medication – United Kingdom
http://www.choiceandmedication.org/cms/?lang=en
Healy, D (2005) Psychiatric Drugs Explained, Elsevier Churchill Livingston:
London.
Trinity College Dublin, The University of Dublin
Next Steps…
Trinity Disability Services
• Developing a general guide to some medications that students may
be prescribed for awareness within Trinity.
• With multi-morbidity of more than one condition prominent
medication guide will be inclusive of primary medications, not just
mental health
• Involvement of Disability service staff, experts-by-experience, and
clinicians in its development.
Trinity College Dublin, The University of Dublin
Thank You
Source Material
Baker, E., Fee, J., Bovingdon, L., Campbell, T., Hewis, E., Lewis, D., Mahoney, L. & Roberts, G. (2013) ‘From taking to using
medication: Recovery-focused prescribing and medicines management, Advances in Psychiatric Treatment, 19(2), pp. 210.
Budgell, B. (2008) ‘Guidelines to the writing of case studies’, The Journal of the Canadian Chiropractic Association, 52(4),
pp.199-204
Department of Health and Children (2006) A Vision for Change: Report on the expert group on mental health policy, The
Stationary Office: Dublin.
Doherty, A.M. & Gaughan, F. (2014) ‘The interface of physical and mental health’, Social Psychiatry & Psychiatric
Epidemiology, 49, pp. 673-682.
E. Power, M. Clarke, I. Kelleher, H. Coughlan, F. Lynch, D. Connor, C. Fitzpatrick, M. Harley and M. Cannon (2015) The
association between economic inactivity and mental health among young people: a longitudinal study of young adults
who are not in employment, education or training’, Irish Journal of Psychological Medicine , 32(1), pp. 155-160.
Healy, D (2005) Psychiatric Drugs Explained, Elsevier Churchill Livingston: London.
Jan F. Wiborg, J.F., Wensing, M., Tummers, M., Knoop, H. & Bleijenberg, G. (2014) ‘Implementing Evidence-Based
Practice for Patients with Chronic Fatigue Syndrome’, Clinical Psychology and Psychotherapy, 21, PP.108–114.
Trinity College Dublin, The University of Dublin
Source Material
M. E. Harley, D. Connor, M. C. Clarke, I. Kelleher, H. Coughlan, F. Lynch, C. Fitzpatrick & M. Cannon (2015) ‘Prevalence of
Mental Disorder among young adults in Ireland: a population based study’, Irish Journal of Psychological Medicine , 32
(1), pp 79 – 91.
Malhi, G.S., McAulay, C., Das, P. & Fritz, K. (2015) ‘Maintaining mood stability in bipolar disorder: a clinical perspective’,
Evidence Based Mental Health, 18(1), pp.1-6.
Mental Health Commission (2008) A recovery approach within the Irish mental health services: A framework for
development, Mental Health Commission [online]. Available at: http://www.mhcirl.ie/File/framedevarecov.pdf
Sheridan, A. (2008) Psychiatric nursing practice: A historical overview, in Morrisey, J., Keogh, B. & Doyle, L. (eds.)
Psychiatric/Mental Health Nursing: An irish Perspective, Gill & Macmillian: Dublin.
World Health Organisation (2013) Investing in Mental Health: Evidence for Action, World Health Organisaiton, Geneva.
[Online] Available at: http://apps.who.int/iris/bitstream/10665/87232/1/9789241564618_eng.pdf?ua=1
Trinity College Dublin, The University of Dublin